江西省某三甲医院产ESBLs肺炎克雷伯菌感染的健康与经济负担

Health and economic burden due to ESBLs-producing Klebsiella pneumoniae infection in a three-A hospital of Jiangxi Province

目的 从医院视角下明确产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌感染导致的健康与经济负担,以期为细菌耐药相关政策干预的评估与优化提供实证依据。方法 收集我国中部某省一家公立综合三甲医院出院时间在2018-2019年的170874例出院患者病案数据,其中产ESBLs肺炎克雷伯菌感染为阳性感染组489例、非产ESBLs肺炎克雷伯菌感染为阴性感染组1162例和非肺炎克雷伯菌感染为非感染组169223例。利用倾向得分匹配法(PSM)、Cox比例风险回归模型、多状态模型和费用成本转换法等计算阳性感染组相对于其他两组分别导致的死亡风险、额外床日数和额外住院成本。结果 经PSM匹配,阳性感染组、阴性感染组和非感染组三组分别纳入489、489和43353例样本。阳性感染患者的死亡风险是非感染患者的1.96倍(P<0.05)。但以阴性感染组为对照时,感染未增大患者的死亡风险。多状态模型结果显示,阳性感染患者相较于非感染患者和阴性感染患者(即归因于产ESBLs肺炎克雷伯菌感染)产生的额外床日数分别为7.99d/例和4.01d/例。而相应产生的额外住院成本分别为14226.34元/例和7139.88元/例。结论 产ESBLs肺炎克雷伯菌感染会增大患者的死亡风险,延长患者的住院天数,增加患者的住院成本。医院应加强感染和耐药情况的监测,优化相关成本管控。

OBJECTIVE To understand the health and economic burden due to extended-spectrumβ-lactamases(ES-BLs)-producing Klebsiella pneumoniae from perspective of hospital so as to provide evidence-based guidance for assessment and optimization of bacterial resistance-related intervention policies.METHODS The medical data were collected from 170874 patients who were discharged from a public three-A tertiary general hospital of a province in central part of China from 2018 to 2019.Among the enrolled patients,489 had ESBLs-producing K.pneumoniae infection and were assigned as the positive infection group,1162 had non-ESBLs-producing K.pneumoniae infec-tion and were assigned as the negative infection group,and 169223 patients had non-K.pneumomniae infection and were set as the non-infection group.The hazard ratio of death,extra hospitalization days and extra hospitaliza-tion cost that were induced by the ESBLs-producing K.pneumoniae infection were calculated by means of propen-sity score matching,Cox's proportional hazards regression model,multi-state model and cost-to-charge ratio.RESULTS By means of PSM,489 cases were included into the positive infection group,489 cases into the negative infection group,43353 cases into the non-infection group.The positive infection patients were as 1.96 times the risk of death as the negative infection patients(P<0.05).Set the negative infection group as the control,the in-fection did not increase the risk of death.Multi-state model analysis showed that the extra hospitalization days(due to the ESBLs-producing K.pneumoniae infection)of the positive infection group was 7.99 d/case as com-pared with the non-infection patients,4.01 days/case as compared with the negative infection patients;the extra hospitalization cost of the positive infection group was 14226.34 yuan/case as compared with the non-infection pa-tients,7139.88 yuan/case as compared with the negative infection patients.CONCLUSION The ESBLs-producing K.pneumoniae infection may increase the risk of death of the patients,extend the length of hospital stay and in-crease the hospitalization cost.It is necessary for the hospital to strengthen the surceillance of infection and drug resistance and optimize the relevant cost control.